Cancer Treatment Costs Leave Many Canadians Struggling

Although Canada has a national mandate to make some medical services universally available, its patchwork of provincial approaches to covering cancer treatment leaves many patients facing tough financial burdens, recent reports have found.

On average, a patient with a cancer diagnosis might face lifetime costs of $32,778, the Canadian Cancer Society said in a December report. This estimate is intended to include not only potential out-of-pocket expenses ($16,018) but also other financial burdens, such as the costs of having to travel for care.

On February 5, the society released survey results that suggested that almost 80% of working-age Canadians (aged 18-64 years) worry that they would struggle to save for retirement if faced with a cancer diagnosis due to out-of-pocket costs. The online survey, conducted in partnership with the Angus Reid Group, included 2044 adult Canadians.

The Canadian Cancer Society has been seeking to draw attention to these burdens. Last year, it published the results of another survey, also conducted in partnership with the Angus Reid Group, that indicated that “a staggering 90% of people in Canada feel a sudden cancer diagnosis would impact their household finances.”

That survey finding caught the attention of Sharlene Gill, MD, MPH, an oncologist and professor of medicine at the University of British Columbia in Vancouver, British Columbia, Canada. It suggested to her that clinicians should more actively ask patients about the financial impact of their diagnosis. “I don’t think that is something that is routinely done unless a patient brings it up,” Gill told Medscape Medical News.

But the issue of financial burden frequently arises without prompting. “It’s a part of an oncologist’s job to also be trying to advocate for their access,” Gill said.

Canadian law makes the provinces and territories responsible for delivering medically necessary hospital and physician services, but patients with cancer have needs that are not always covered. So oncologists and other members of the teams caring for patients with cancer tend to be well versed in the local programs and resources to which they can refer their patients.

Social workers are playing an increasingly important part on healthcare teams, Gill said. “Patients may need a wig, or they ended up with an ostomy and they need ostomy supplies, or they have breast cancer and need a breast prosthesis,” Gill said.

Shock at the Pharmacy

Patients with cancer often struggle to pay for the antinausea medicines that are needed to make their treatments tolerable. A 2019 government report about efforts to expand drug coverage made this point.

“There is no one consistent way that all cancer patients obtain take-home cancer drugs or medicines for coping with chemotherapy side effects. Some pay more. Some pay less. Some don’t have access to those medicines at all,” wrote Eric Hoskins, DPhil, MSc, MD, in the report.

Hoskins served as chair of the Advisory Council on the Implementation of National Pharmacare, thus this 2019 report is known as the Hoskins report. It’s a key document for recent efforts aimed at establishing a universal pharmacare program.

A law passed last year directs the federal government to sign agreements with provinces and territories to fund coverage of birth control and diabetes medications, while efforts toward a universal pharmacare program continue. British Columbia last year said that it would work with the federal government on this effort. But to date, no formal agreements have been signed with any province.

It’s unclear whether the pharmacare plan will be implemented. The law was the product of a now-defunct agreement between the Liberals and New Democrats, in which the latter supported the minority government in exchange for policy concessions. The law has been criticized by groups including the pharmaceutical industry and Conservatives.

In an editorial last year, the Globe and Mail noted that around 40% of prescription drug spending in Canada is covered by various federal and provincial insurance plans, around 40% by private insurance, and about 20% covered out of pocket. “The Liberal government’s pharmacare bill, which envisions supplanting the private insurance market for a public one, is largely a solution in search of a problem,” mentioned the newspaper.

Still, even patients with insurance can experience an unpleasant surprise when buying antinausea medicines. Joanne Wells aged 56 years, of Cupids, Newfoundland, recalled such a surprise early in the treatment journey of her husband, Rod Delaney aged 57 years, who was diagnosed with lymphoma in 2012.

“He had to take these three pills, the hospital called them golden nuggets, to help with nausea. They were $80 each. I was in shock when I went to the pharmacy,” Wells told Medscape Medical News.

The tab for another drug Delaney needed following a stem cell transplant left the couple “floored.” It cost more than $2000 for a month’s supply, he said.

Delaney and Wells expressed gratitude that they had found jobs that provided supplemental insurance and income to cover the expenses of cancer treatment. These expenses included travel for treatment, including a stay in Ottawa for chimeric antigen receptor (CAR) T-cell therapy in 2023.

But Delaney and Wells also detailed how these added expenses, plus disruptions in work, have changed their lives. For example, before Delaney’s diagnosis, they had been thinking of retiring soon. Instead, they’ve had to make major lifestyle shifts in search of financial stability. For example, Delaney changed jobs from serving as an executive chef at the St John’s convention center to being a general manager at a franchise.

In 2020, he had about $18,000 in costs related to medical expenses. “Revenue Canada came back to me and asked me to justify all these claims,” Delaney said. “I was easily able to justify it because one thing my wife has taught me very well is to document.”

Gill reported having no relevant financial relationships. Delaney and Wells received reimbursement from Gilead for a trip to California and a tour of a CAR T-cell facility.

Kerry Dooley Young is a freelance journalist based in Washington, DC. She’s reported on healthcare and medicine for more than 20 years.